[estearum]

Sure, in the same way "the market" discovered that cigarettes cause significant health problems.

Step 1. Ensure extremely widespread use to ensure that effects are noticed relatively quickly (i.e. within a few decades)

Step 2. Hope someone notices correlations between that drug use and the positive/negative downstream effects.

Step 3. Hope someone who has access to the data required to actually conduct an observational study actually wants to run the observational study. By the way, you better hope all the info you need is available in insurance claims data (it's not) because that's really the only data you'll have at high scale. For most of these fraudulent drugs, you won't even have that! Because why would you go through the hassle of gaining reimbursement when you can just sell bullshit for cash? So in practice the required real-world data on these drugs and their effects literally will not exist in most cases. Where the data does exist, it'll be confounded by the unrecorded use of all the other fake drugs too.

Step 4. Hope the company selling a non-working drug doesn't have the clever idea of publishing countervailing "studies" backed by much larger budgets and with more existential motivation. They won't be assessed by FDA so these studies can just say whatever they want, of course.

Step 5. Lobby for outlawing of a drug that, in fact, didn't break any law whatsoever. Obviously it can't be illegal to sell a non-working in a regime that has no way to assess whether a drug works. So you really just gotta hope to post enough times that a drug is bad that people stop taking it.

But cigarettes' negative effects are significantly stronger than most drugs' positive (or negative) effects. So every single step is going to be dramatically harder, require more people taking the drug, more data, more time, more sophisticated analysis, more direct scrutiny from "the market."

Give it a few decades and, maybe a couple hundred or couple thousand deaths, and with a bit of luck "the market" will have eliminated one of the thousands of fake drugs proliferating across the market.

Thankfully for the company behind it, they can always just start up another totally legal fraud by just picking a different chemical (inert or not) and claiming a different medical benefit.

Oh yeah, meanwhile, doctors are just flooded with absolute bullshit claims 24/7 with no repercussions for anyone just lying to them. It's good stuff.

Literally one of the dumbest ideas I've ever heard.

[qsera]

Not sure, I was just talking about the efficacy, not long term side effects. The parent comment was also talking about showing efficacy...

>Literally one of the dumbest ideas I've ever heard.

It is capitalism 101. Not sure if that is the dumbest idea, because the whole world seem to run on it.

[estearum]

> But cigarettes' negative effects are significantly stronger than most drugs' positive (or negative) effects

I am clearly talking about both positive and negative effects of drugs. Both would be generally extremely hard to detect, and literally impossible to detect without both 1) massive consumption of that drug and 2) a civilizational-scale rewriting of the data infrastructure that actually exists.

Perhaps you should explore Capitalism 201. You'd learn that markets only have all their most lovely features in an environment of complete information, which this is not. The more the information asymmetry (or complete ignorance) there is, the less-well markets work.

The proposal being put forth here is: what if we just had virtually no actual information about these products?

Well, the markets don't work. Capitalism 201.

[qsera]

>I am clearly talking about both positive and negative effects of drugs.

Then you are answering to a point that was not raised.

> most lovely features in an environment of complete information, which this is not. The more the information asymmetry (or complete ignorance) there is, the less-well markets work...

I am well aware. But for what I as well as the parent is saying, this only require information regarding if the thing works or not for the people who use it as long as that information is not censored.

[estearum]

Uhh... the question was "can the market detect efficacy." My answer is: Generally no, and it also can't detect negative effects either.

That's answering the question.

> this only require information regarding if the thing works or not for the people who use it as long as that information is not censored.

Can "the market" currently detect whether there is complex life in the Messier 54 star cluster?

No.

Is it because that information is censored?

No.

It's because that information doesn't exist.

Or more specifically, because that information is indistinguishable from noise. Even in the scenario of cigarettes' extremely strong effect (stronger than nearly every drug) deployed at massive scale (higher scale than nearly every drug), it required decades to establish causality.

Especially in the regime of drugs being released to market solely on safety data, the information about whether they work would be generally indistinguishable from noise. For way, way longer than cigarettes given the smaller population, smaller effect sizes, and the (presumed) proliferation of noisy concomitant "medications."

Do you think companies spend billions of dollars running RCTs for fun? The FDA doesn't require RCTs, they require only strong evidence of efficacy and safety. They do ultra-expensive RCTs because without them, it's virtually impossible for anyone to know – including the patients themselves – whether the drugs work.

[qsera]

>because that information is indistinguishable from noise.

Not if the signal is strong. Whether a thing works or not, is a pretty strong signal. Your equating it to bad effects of smoking is flawed and is not comparable.

You other arugments are also pretty bizzare, but not going into that for sake of focus.

[estearum]

Well, with an argument like that!

> if the signal is strong, it will be visible

> your specific example of it taking decades of massive deployment and close scrutiny to detect an effect significantly stronger than most drugs is ummm... flawed and not comparable for no reason I can articulate

okay buddy

That's okay, you're someone who thinks the FDA is in cahoots with insurers and drug companies to approve ineffective or unsafe drugs at scale lmao. And here you are arguing that the market would actually naturally detect exactly that.